Sunday, April 10, 2016

March/April Goals - Eat Food

Once again, I'm late with reflecting on last month's goals and setting out this month's goals.  Perhaps my goal for this month should be to be on time with my next post about goals?

Anyway...for March, I made a very vague commitment to "recognize what I need and to meet those needs".  I was feeling in a bit of a slump at the time, and I couldn't quite figure out what would make me feel better, so my goal was essentially an attempt to identify anything that would make me feel better and do it.  After a few days of self reflection, I realized that one of my biggest sources of unhappiness was feeling like I was spending all of my time doing the tedious parts of my job (dictating, editing dictations, reviewing labs) without ever being finished with it.  In response to this, I made it my priority to get all the stuff done, and I did.  (As I wrote about here).

In getting caught up on my work, and even more so in trying to prevent the work from reaccumulating, I have come to realize that I was making the fatal mistake of letting my work expand to fill the time available to me.  I'm usually in clinic only about 50% of the time, leaving me with more than enough time for office work when I'm not on call, and I was allowing the tedious work to unnecessarily fill up all of my non-clinic time.  I would come in a bit late, have a nice long coffee break, check Facebook, and do all kinds of things to procrastinate getting the work done because there wasn't a real urgency to doing it.  When I had another project to work on, such as a presentation with a firm deadline, then I would get more efficient at the tedious work to make time for the other project, but otherwise I was dawdling.  And feeling trapped in paperwork hell.

Forcing myself to finish my tedious work on a daily basis (as much as possible) has made me much more efficient.  I come in on time, I minimize non-work activities, and I use even the random five- or ten-minute chunks of available time between events to be productive.  There is absolutely no way that I want to stay later than I need to because I've been scrolling through Facebook instead of signing off on dictations.  By making much better use of my time, I've finally freed up some of the big chunks of time that I need for bigger projects.  Which feels awesome.

So, March goal?  Let's call it a success.

April Goal - Eat Food:

A lot of my time with patients is spent counseling them on living a healthy lifestyle.  Many of them hope that I hold a magical secret to living better, but in reality, my advice to them is always pretty basic:  Get exercise (30 minutes per time, 3-5 times per week).  Eat more healthy food (fruits, vegetables, lower-fat dairy, lower-fat meat/meat alternatives, whole-grain products).  Eat less unhealthy food (pop, chips, fast food, processed food, sugar).  Simple in theory, frustratingly difficult in practice.

After spending my days giving (what I think is) fundamentally sound advice, I unfortunately often go home and sit on my couch eating precisely the things I tell my patients not to.  I love pop.  And chocolate.  And ice cream.  And eating out in almost any restaurant, including the greasiest of greasy spoons.  I am an extraordinary hypocrite, and I know it's something I need to work on. 

About a week ago, my girlfriend and I watched an excellent documentary featuring Michael Pollan, an author who has written books about the problems with the industrial food system and with our current approach to eating healthily.  The documentary focuses around Pollan's simple advice on how to eat:

As I was watching the documentary, I was struck by how simple the advice was, and by how horribly I fail to live up to it.  Even though I actually like real, unprocessed, healthy foods.  The main reason I eat so much bad food is laziness and accessibility, both of which I can change.  So...I'm making two commitments for the months that fall under the heading of "Eat Food". 

1)  No pop.  It's something I don't need, and it's one of the worst things I can possibly consume.  So for this month (if not longer), I'm done with it. 

2)  Take one fruit and one vegetable in my lunch every day.  It's a small start, but it is at least a start.  I bought an assortment of vegetables at the grocery store today, I've cut up a bunch of vegetables to take in my lunches, and I'm ready to be successful at this one.

Now I'm off to Red Lobster for dinner.  I wonder if they sell any real food....

Friday, April 8, 2016


Tonight I went to a talk about climate change by Naomi Klein, a Canadian writer and activist.  Going into it, I was worried that it was going to be a depressing lecture about how the Earth is doomed, complete with photos of polar bears floating adrift on melting icebergs.

Instead, the talk was a call for transformation - from fossil fuel to renewable energy, from a profit-driven economy to a human-centred society, from isolation to community.  It was 90 minutes of a left-wing, granola crunchy vision for humanity*, and I loved it.  Her talk encompassed everything I believe about how the world should strive to operate, only articulated in a vastly more intelligent and entertaining way than I ever could.

As I listened, I was hopeful that the world might just be capable of realizing the things I believe in:  environmental sustainability, racial/gender/sexual equality, empowerment of the poor and the marginalized.  And I wondered, what is my role in this?  As a physician (and as a queer, able-bodied, white, upper class woman), how do I live out my values and contribute to the society that I want to see?  How do I move beyond earning a paycheque and paying off debt to making a lasting change in my community?

I don't quite know yet, nor do I have the energy to really delve into this question late on a Friday night, but it is definitely something to think about.  Any ideas?

*Supported by a very solid research base and understanding of economics/politics/world systems. 

Tuesday, April 5, 2016

Happiness Over Money

Years ago, soon after I had started medical school, a friend of mine who is a physician came in from out of town for a visit.  During his stay, I inundated him with questions about medicine and work life balance and time off for physicians.  When the subject of vacation came up, I was quite surprised to hear that he could take almost as much time off as he wanted to, but he didn't.  It was, he said, too hard to give up the money.

At the time, I didn't understand.  I viewed vacation as a wonderful time of happiness and freedom, and I couldn't imagine passing it up for more money when doctors already make lots of money.

Fast forward eight or nine years, and I understand completely.  When the amount you earn is directly proportional to the amount you work, and especially when you still have 5-10 years of debt repayment ahead of you, it's really hard to justify time off from work.  Every day off is a calculation: 

One half day of clinic x X patients/half day x $Y/patient = I think I'll go to work.  

It's so easy to look at that calculation and think that I don't need a vacation and that it's okay for me to miss out on the things that make me happy.  Except that I do.  And it isn't.

So I'm learning to value my time more than my income.  It started today, with cancelling a half day clinic so that I can go to a really interesting conference on work life balance.  And then, emboldened by that decision, I decided to take an entire week off during our local theatre festival.  A week!  It took me hours to commit to the decision, but now that I've made it, it feels right.  It feels entirely right for me to make time for something that I love that gives me joy.

After all, why else am I here?

Wednesday, March 30, 2016


For weeks (months? years?) I've been feeling overwhelmed by work.  My desk has been covered with charts and lab results, my dictation inbox has been overflowing with letters to edit, and I've been weeks behind on my to do list.  No matter how much effort I put in, it seemed like I was never doing any better than keeping the piles from growing larger.  And I hated it.

About two weeks ago, I had finally had enough of all of the things that loomed over me, so I made it my goal to get caught up on everything.  Everything.  Whenever I had a spare minute, I tackled the things that needed to be done.  I went into work early and stayed late.  I worked through lunch.  I logged on from home when I had extra time in the evenings or on weekends.  I worked my butt off, and I got shit done.  And now?  I'm caught up.  There are zero charts on my desk and zero dictations to sign off on.

All done.

It feels amazing.  I no longer want to scream at my administrative assistant* when she brings a pile of lab results into my office.  I have actual time to do the big picture things, like read journal articles and prepare presentations and (maybe someday) finish the article on my fellowship research.  By getting caught up, it is now possible to keep up with the things that come in every day and to stay caught up. 

Best.  Feeling.  Ever.

The only problem?  I'm so used to existing in a state of chaos and panic that I don't know how to function with the stress gone.  With nothing screaming at me to pay attention to it, it's hard to pay attention to anything.  How is a procrastinator to function once they stop procrastinating?

*I have never done this, because I'm not a jerkface.  Any physician who yells at people in his or her workplace (or anyone else, for that matter) is a jerkface.

Friday, March 25, 2016

Notes Towards a Poem That Can Never Be Written

"The facts of this world seen clearly
are seen through tears;
why tell me then
there is something wrong with my eyes?

To see clearly and without flinching,
without turning away,
this is agony, the eyes taped open
two inches from the sun." - Margaret Atwood

Part of my girlfriend's job involves resettling Syrian refugees.  After experiencing almost unspeakable horrors in their home country, these people have now traveled halfway across the world to a foreign city searching for something better.  Which they don't always find.  The cold and the grey of a Canadian winter, even as it begins to melt into spring, isn't always inviting.  The residents of my city too aren't always welcoming towards more people who will need government support (more taxes on the already overtaxed) to establish themselves.  The low-income housing into which people are placed doesn't always match with the image of an affluent Canadian city.  Life here can be hard.

And so they talk.  They talk about many of the sad things from their pasts and about the disappointment that they don't leave the sadness behind when they physically leave their country.  They talk to my girlfriend, and she listens because she's a good person and can feel these people's need to unburden themselves, if only a little.  With each story, each heartbreaking story, some of the weight of their experience transfers from them to her.  Their loads lighten, hers becomes heavier.

And I see it in her.  I see it in how she laughs a little bit less and seems a little bit more distracted when we talk.  I see it when I awaken in the night, and she is already awake, her mind unable to rest.  And I know what it is like, to bear witness to the suffering of others, and to feel powerless.

And I wonder, how do we - the doctors, the nurses, the social workers, the myriad of helpers - stay intact?  How do we witness these things and not be destroyed by them?  How do we keep coming back, day after day, offering what little we have to offer, when all we see is the neverending need?

Sunday, March 20, 2016

Why I Continue to Live the Frugal(ish) Life

One of the best people I met during my fellowship training was our Educational Coordinator, S*.  S is slightly older than I am** and married later in life, so she could empathize with me during both the single-career-woman-looking-for-love and the single-career-woman-falling-in-love stages of my training.  She was also a huge advocate for me and the other fellow, which was invaluable in dealing with a system that was often indifferent and occasionally blatantly hostile to its trainees.  When I finally finished my training, one of the few things that made me sad was no longer working with her on an almost daily basis.  (Everything else was bliss.)

While I liked S from the very beginning, I really bonded with her after I abandoned my spendy ways and started living more frugally.  She would stop at my desk to chat fairly regularly, and one day we got talking about money after she caught me binge reading the great Mr. Money Mustache.  It turned out that she had learned to be frugal while living as a single person, and she'd carried that approach into married life, such that she and her husband currently live off a single income and bank the second one for retirement.  Over the remaining months of my fellowship, we talked regularly about the freedom that comes from living well below your means and about all the sources of happiness that don't require money.  In a financial sense, she and I clicked.

Which is why I was surprised the other day when I ran into her in the hallway, and she asked me "Are you getting used to living like an attending now?"  Her assumption, like everyone else's, was that I had abandoned frugal living as soon as my first fee-for-service patient entered my clinic.  In reality, for anyone who is curious, I'm living on almost exactly the same budget as I did during fellowship***, and every additional dollar I earn is either getting saved or applied to my debt.  Which makes many people (my accountant, my financial advisor, my spendthrift physician friends) ask me "Why?"  They point out, quite legitimately, that I could afford to be more liberal with my spending and to buy a house and a car that doesn't have a giant chunk out of its rear end.  They simply don't get why I keep living like a fellow despite my attending's salary.

For me, the answer is easy:  choice.  As long as I am in debt, as long as I am spending most or all of the money that I earn, then I have to keep working long hours as a physician.  If I buy the big house and the fancy car, then I'm always compelled to earn a high income to pay for them.  Which isn't so bad now, when I'm fresh from training and still somewhat keen, but who knows how I'll feel in 10 or 20 years.  Maybe I'll want to stop working full time and take three-day weekends every week.  Maybe I'll be sick of my subspecialty and want to retrain in another field.  Maybe I'll burn out altogether and want to move to the West Coast to smoke pot.  Who knows?  All that I know is that saving money now, and living on less, means that I can practice medicine because I choose to, not because I have to. 

Even in the short-term, frugality makes life better.  I can work at an inner city clinic, where I earn slightly less ridiculous amounts of money than I would at a tertiary care centre, because I don't have to maximize my salary at the expense of my happiness.  I can say no to extra weekends of call, even though I usually don't****.  I can sleep better at night knowing that I'm within a few months (maybe as little as two?) of having a legitimately positive net worth, even without counting my car.  All of this is way better than a $30 bottle of wine or a $200 dinner out. 

And let's be honest:  I'm really just pretending to be frugal.  I'm not living a Frugalwoods life of 10-cent rice and bean lunches over here.  I'm living off of more than the average family in my city.  I'm traveling to the Middle East in May, and I'm going out for Korean food tonight, and I'm buying weekend passes to our local music festival instead of volunteering.  As my accountant said recently, I'm living a "relatively modest" life.  It's only in comparison to the crazy excesses of many doctors that my life is in any way frugal.  And for that, I'm very lucky. 

*I'm so creative with the names.  You're welcome.

**5 years?  10?  15?  I'm terrible at guessing ages.

***I added $200 per month to my travel budget, because we love to travel and have some big trips planned this year, and I threw a bit of money at my budget to make up for the Great November Debacle so that I wouldn't have to spend a year recovering.

****That will happen once I hit a positive net worth.